The World Health Organisation laid down a simple principle years ago. Namely that people who go to prison should be entitled to the same standard of health care inside as they would get on the out. Now we’d all agree that standards of healthcare for drug users in the community vary considerably. Try getting a detox or a script in many areas of this country. We’d also agree that where detox beds (or home detox) and scripts are available, there’s considerable variation in the quality of these things and the way in which they’re delivered to you. BUT, all that said, you’d be hard pushed to find as much variation as there appears to be in prison healthcare provision. Okay, we know that the piss-poor quality of healthcare provision in many nicks has been officially recognised (see, for example, the response from the Governor of Styal in this issue). We also know that the whole of prison healthcare provision is going to be handed over to the NHS (or what’s left of it when Tony’s finished flogging it off), but there’s still a lot wrong with what passes for prison medical services and we have to put the pressure on.

"It takes a lot of time to tackle a drug problem and the way they tackled it was stupid. I was reduced too quickly and it made me ill."

Where this provision is perhaps most sadly lacking is in what is now called the ‘Women’s Estate’ (they’ve lumped all the women’s prisons together now, with a common overall management). And the thing that points up how dire prison health services in women’s jails can be is around detoxification. In our last issue (no. 5), we printed a letter from a very brave lady (brave because of the dangers of victimisation should she return to the system) called Tracey Wimbleton detailing her experiences at of detox at Styal Prison. Since Tracey wrote to us, we have had a number of personal communications from former inmates of this nick, all making similar allegations of a link between detoxification provision and drug using prisoners attempting to harm themselves. Attempts ranging from self-cutting to actual suicide attempts.

"The medication they give you is not enough, leaving you withdrawing. I think if they are going to detox someone they should do it properly as this is the hardest time for a prisoner"

"They told me they don’t like helping people with drug problems"

This got us looking at the official literature on ‘self-harm’ (as it’s euphemistically called) and women prisoners. Now when you read this stuff what you find are accounts that blame the women themselves in one way or another, or others that blame aspects of the experience of imprisonment or prison regime. Where people try to put the blame on the women themselves, it’s all in terms of their poor mental health, experience of sexual or physical abuse, drug and alcohol use, or the ‘poor coping skills’ some prisoners have! Straight up. They even have a label for people who harm themselves in the nick, ‘poor copers’. Doesn’t that take the biscuit? Imagine telling the relatives of people who topped themselves in Nazi concentration camps or Russian labour camps in the Arctic circle that the reason their nearest and dearest did away with themselves was that they were ‘poor copers’. Nothing to do with the regime, the brutality or anything else. Simply a matter of some people not being able to ‘cope’. Soft, ungrateful bastards who just couldn’t cope with a brisk regime and no TV imagine!

"You get fobbed off and have great difficulty in seeing a decent doctor. The doctor here is known as Doctor No because he won’t give you anything, even a lot of the staff know this”

Oh well, better luck with the literature that looks at prison regimes and facilities. Or, so you would think. Certainly aspects of prison experience and regime are blamed here. Things such as being put in strip cells if you attempt self-harm. Staff attitudes, nature of prison management and so on. But no one has looked at how often and how much of, attempts at self-harm of all kinds occur among women who enter prison with a habit or a methadone script or both and then find an inhumane detox awaiting them. When will they look at this relationship as a possible trigger for self-harm? We know that the bulk of self-harm attempts happen to remand prisoners, men and women, but we do not know how many of these were drug users or what the detox regime in a particular nick is like. The new Prison Inspector is a woman. We have already written to her, before she has even taken up the job, about Tracey. Now we’ll send her this issue, with our suggestions for a new line of research into self-harm among drug users in nick. Including our suggestion that most women prisoners shouldn’t be in a nick in the first fucking place.

“When I first came into prison I needed a detox for my heroin addiction but was given nothing by the doctor as for some reason he didn’t believe I was using heroin even after I told him to ring my mother to confirm it, he told me I looked well enough to him and told me to go special sick two days later if I got any worse so I did my cold turkey raw with no medication at all"

But, just to show that there’s another way, here’s a brief description of one Swiss women’s prison and how they treat drug users. Here you are girls, imagine that you’ve been using gear for two years minimum, you’ve failed detox, rehab or methadone maintenance in the past, you’re over twenty and you’re suffering from depression, Hep C or whatever. Also you’ve got at least 9 months left to serve. If so, you could be a candidate for heroin maintenance if you were in Oberschongrun nick in Switzerland. You’d be moved out of the general population, live and work in small groups. You’d get heroin three times a day provided by prison nurses supervised by a screw and you’d get to give yourselves a dig. Alternatively, you could try doing your time at Bale and get injectable methadone. We’re not saying that’s the answer. One of the things they were interested in with this prison heroin trial was whether it helped inmates adjust to prison life and discipline better. Wouldn’t that be nice? A bit like the unofficial tolerance of draw by prison staff in England. "It keeps ‘em quiet". Heroin certainly does that. Still it shows you that you don’t have to come to prison as a punishment and have poor health care as an added punishment. Write to us and tell us what you think. And what about men’s prisons?

"I was told to be a man and come off drugs the hard way. The medical staff just don’t give a damn about drug addicts. I’m just another junkie to them."

The quotes on these pages come from unsentenced male and female remand prisoners and are taken from the HM Chief Inspector of Prisons report on the treatment and conditions of remand prisoners.